Why Rwanda leads East Africa in healthcare

Rwandan President Paul Kagame

Mobhare Matinyi, Washington DC. The Citizen, Thursday, 12 July 2012 21:11

Once again, Rwanda leads in the East African Community (EAC) in one important aspect - government expenditure on healthcare per capita, that is, the average amount of money in US dollars that a government spends per person per year based on official exchange rate. Rwandan government spent $48 on each individual’s healthcare in 2009 according to the most recent report.

The Rwandan amount is almost twice as much as Tanzania’s $25 in fourth place, but what is so surprising is that Rwanda has increased spending fivefold since 2000 while Tanzania has increased only two and half times from $10.07. This news may not be a surprise but is still important considering the fact that Kenya and Tanzania have recently been hit by medical personnel strikes.

In December 2011 Kenyan doctors went on strike and within a month their counterparts in Tanzania did the same, in both cases the issues being pay and working conditions. In March 2012 Kenyan nurses went on strike before Tanzanian doctors resumed their strike in June which is still troubling the nation.

According to the report published by the Society for International Development (SID), Uganda had the second highest per capita healthcare expenditure with $43 followed by Kenya with $33 and as usual Burundi was the last with $20. There is a lot of financial data on healthcare expenditure, but this one piece regarding per capita expenditure paints a very lucid picture on how strategic each country is.

Since Tanzania is going through a crisis, let me zero in on it based on World Health Organisation (WHO) data covering the period between 1995 and 2009. Starting with total healthcare expenditure as a percentage of Gross Domestic Product (GDP), Tanzania spent 3.77 per cent in 1995 and this figure never went up significantly until 2006 when it spent 6.53 per cent. By 2009 the figure had dropped to 5.12 per cent. Notably, the United Nations wants Tanzania to reach 15 per cent.

From another observation, in 1995 the government spent 40.10 per cent of the country’s total healthcare expenditure with the remainder coming from non-government sources, but come 2005 the government raised it to 48.51 per cent. As a result of massive donor support by 2009 the government was spending 73.59 per cent.

In absolute amount of money presented in US dollars, based on official exchange rate, in 1995 the country spent a total of $114 million with the government spending $46 million of that, about 40 per cent as mentioned above. As of 2009 the country spent $1,462 million of which the government share was $1,076 million, with the Ministry of Health spending $596 million.

Looking at donor support one may be surprised at the figures. Back in 1995 external resources on health as a percentage of total health expenditure was only 9.29 per cent, but that figure reached 36.48 in 2005, then jumped to 59.21 and 56.47 per cents in 2008 and 2009 respectively. Imagine if donors say enough is enough, you have adequate natural resources, please take care of yourself!

Another dimension is general government expenditure on healthcare as a percentage of general government expenditure which gauges the attention of government on healthcare. In 1995 the figure was 9.13 per cent, increasing to 14.40 per cent in 2006 before reaching 18.08 per cent in 2009, twice as much as it was in 1995. Not bad, but still more is needed.

When he addressed the nation on June 30 in his monthly speech, President Jakaya Kikwete hinted that his government has increased the healthcare budget from Sh300 billion in 2005/06 to Sh1.2 trillion in 2011/12, making it the third largest area after infrastructure and education. Note that, average annual inflation rate was below 5 per cent in 2005/06 but has mostly been above 10 per cent since October 2008, and is currently close to 19 per cent.

While in local currency this appears to be a fourfold increase, in foreign currency that isn’t the case. WHO data shows that in 2005 it was $301 million, and based on the current average exchange rate, the 2011/12 amount is about $750 million approximately two and half-times. Again, impressive but not enough!

Frankly, based on our pathetic situation, population explosion, and other known challenges, we need to do far better than this. So, where is the magic wand? We need to increase our GDP and the nation’s total expenditure on healthcare as well as the government’s spending; assuming embezzlement and corruption will not interfere.

Finally, it is time we escaped from donor-dependency syndrome if we truly want to be in charge of our own destiny. This is not to mention a host of measures such as effectiveness and efficiency, training, equipment, facilities, various public health programmes and taking care of our medical personnel. I don’t think being overtaken by almost all EAC members is a good sign at all